A giant subcutaneous leiomyosarcoma arising in the inguinal region

BACKGROUND: Subcutaneous leiomyosarcoma is a rare condition that accounts for 1% to 2% of all superficial soft tissue malignancies. Approximately 10% of cases arise in the trunk, although the extremities are the most commonly affected. CASE PRESENTATION: We report herein the case of a 31-year-old man with a subcutaneous leiomyosarcoma, measuring 124 × 105 mm, arising in the left inguinal region. A wide local excision (with a resection margin ≥ 20 mm) was performed. Histological examination of the resected specimen revealed a leiomyosarcoma with high cellularity and two mitoses per 10 high-power fields. The patient remains well with no evidence of disease 5 years and 8 months after the operation. CONCLUSION: This is the first reported case of subcutaneous leiomyosarcoma arising in the inguinal region and also one of the largest tumors reported. The experience of this case and a review of the English-language literature (PubMed, National Library of Medicine, Bethesda, MD, USA) suggest that a resection margin of ≥ 10 mm is recommended when excising this rare tumor

CENP-A Phosphorylation by Aurora-A in Prophase Is Required for Enrichment of Aurora-B at Inner Centromeres and for Kinetochore Function

AbstractThe Aurora (Ipl1)-related kinases are universal regulators of mitosis. We now show that Aurora-A, in addition to Aurora-B, regulates kinetochore function in human cells. A two-hybrid screen identified the kinetochore component CENP-A as a protein that interacts with Aurora-A. Aurora-A phosphorylated CENP-A in vitro on Ser-7, a residue also known to be targeted by Aurora-B. Depletion of Aurora-A or Aurora-B by RNA interference revealed that CENP-A is initially phosphorylated in prophase in a manner dependent on Aurora-A, and that this reaction appears to be required for the subsequent Aurora-B-dependent phosphorylation of CENP-A as well as for the restriction of Aurora-B to the inner centromere in prometaphase. Prevention of CENP-A phosphorylation also led to chromosome misalignment during mitosis as a result of a defect in kinetochore attachment to microtubules. Our observations suggest that phosphorylation of CENP-A on Ser-7 by Aurora-A in prophase is essential for kinetochore function

Dysfunction in Defecation and Its Treatment after Rectal Excision

Abstract: Various types of dysfunction in defecation are known to develop after low anterior resection for/in the treatment of rectal cancer. In particular, the lower the level of anastomosis, the more serious the disturbance. This disturbance is characterized by a variable frequency of defecation and urgency. To improve this condition, colonic J-pouch anal anastomosis was reported as an option. In this technique, a colonic J-pouch was constructed and anastomosis was formed with the anus to restore stool reservoir function. This technique has been performed since 1988 at our institution. It was observed that approximately 3 years after the operation stool frequency was significantly decreased, the development of urgency was reduced, and the defecation function was improved, compared with straight coloanal anastomosis. This improvement in the function of defecation appeared to be largely influenced by both an increase (approximately twice) in the capacity and the compliance of the colonic pouch. Since these results were not derived from randomized trials, the published results of randomized trials were investigated, and are also discussed below

<原著>胆道癌に対する大量肝切除後に出現する高ビリルビン血症

Serum bilirubin concentrations were examined in patients who received hepatectomy for biliary tract carcinoma. They were divided into two groups according to the presence or absence of preoperative obstructive jaundice (POJ): the POJ group (n = 14) and non-POJ group (n = 10). The POJ group underwent percutaneous transhepatic drainage to delineate jaundice before definitive surgery. Total bilirubin concentration in the POJ group had increased at 1, 3, 5, 7 and 14 days after operation compared to the non-POJ group; the direct bilirubin level had increased at 1, 3, 5 and 7 days, and the indirect bilirubin level had increased at 1 and 3 days. Liver functional data before and 14 days after the operation were similar for the two groups. The incidence of cholangitis was higher in the POJ group than in the non-POJ group. Blood loss was greater in the POJ group than in the non-POJ group. The morbidity rate in the POJ group was higher than that in the non-POJ group. These results suggest that characteristic hyperbilirubinemia developed after major hepatectomy in patients with biliary tract carcinoma, and the bilirubin response is evoked by underlying preoperative biliary passing disturbance.大量肝切除が行われた胆道癌24例を対象に血清ビリルビン濃度の推移を検討した. 対象を術前に閉塞性黄疸を来した群(POJ 群, 14例)と閉塞性黄疸を来さなかった群(non-POJ群, 10例)とに分配した. POJ 群には術前に減黄の目的で胆道ドレナージを施行した. 総ビリルビン濃度は手術直前に群間差を認めなかったが, 術後 1, 3, 5, 7, 14 病日に POJ 群で高値を示した. 直接ビリルビン濃度は術後 1 3, 5 7 病日, 間接ビリルビン濃度は術後 1, 3病日に POJ 群で高値となった. 肝機能指標は手術直前及び術後14日間で群間差を認めなかった. 胆管炎の頻度は POJ 群で高率であった. 出血量と合併症は POJ 群で多く見られた. これらの所見から, 胆道癌に対する大量肝切除後には特徴的な高ビリルビン血症が発症すること, そうしたビリルビン反応は術前から併存する胆道の通過障害に由来することを推定した

Regional lymphadenectomy for gallbladder cancer: Rational extent, technical details, and patient outcomes

AIM: To define the rational extent of regional lymphadenectomy for gallbladder cancer and to clarify its effect on long-term survival

<原著>二酸化炭素気腹で抑制される豚の門脈血流量はドパミン投与によって回復する

Portal venous blood flow (PVF), hepatic arterial blood flow (HAF) and systemic arterial pressure (SAP) were examined after dopamine (DA) injection into the jugular vein under carbon dioxide pneumoperitoneum in pigs. When intraabdominal pressure (IAP) was increased by 12 mmHg, PVF and HAF were reduced, but SAP was unchanged. When IAP was kept at 12 mmHg, the injection of DA at 10 μg/kg/min for 2 min produced an increase in PVF without causing any change in HAF or SAP. The response in PVF was dose-dependent. When IAP was increased to 16 mmHg, PVF response was diminished, and no change in HAF or SAP was seen at the same dose of DA. These observations suggest that DA is effective in increasing PVF under enhanced IAP conditions, but such circulatory improvement due to the agent would be prominent when IAP is below 12 mmHg.豚を用いて二酸化炭素気腹下でドパミンの頸静脈投与が門脈血流量, 肝動脈血流量, 体血圧に対する影響を調へた腹腔内圧を 12 mmHg まで高めると, 門脈と肝動脈血流量は減少したが, 体血圧には変化を認めなかった. 腹腔内圧を 12 mmHg で維持した状態で, ドパミン 10 μg/kg/min で2分間の投与は肝動脈血流量と体血圧に変化を与えることなく, 門脈血流量を増加させた. こうしたドパミンによる門脈血流量反応は用量依存性を示した. 腹腔内圧 16 mmHg では同用量のドパミンの投与で, 門脈血流量反応は低下したが, 肝動脈血流量と体血圧には変化を認めなかった. これらの観察から, ドパミンは腹腔内圧上昇時に肝門脈血流量を増加させること, しかしそうしたドパミンの肝循環改善効果は腹腔内圧 12 mmHg 以下で顕著であることを導いた